Fibroids Flashcards

1
Q

Fibroids medical Mx

A

Conservative if asymptomatic
Treatments for HMB
Injectable GnRH agonist
Ulipristil acetate

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2
Q

Treatments for HMB

A

LNG-IUS (1st line)
Tranexamic acid
Mefenamic acid
COCP

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3
Q

Which fibroid unaffected by HMB treatments?

A

Submucal fibroid or enlarged uterus palpable abdominally

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4
Q

Injectable GnRH agonists ib fibroids?

A

Only widely proven effective medical Rx
Induces menopausal state shuts down ovarian oestradiol
poorly tolerated

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5
Q

Ulirpristil acetate in fibroids

A

SPRM
reduces size and HMB Sx
Not yet widely used
Does NOT induce menopausal state

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6
Q

Medical Mx of fibroids, is it possible?

A

Not long term

Fibroids regrow when ovarian function returns

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7
Q

Surgical Mx of fibroids

A

Depends on Sx

  1. Minimally invasive hysteroscopic
  2. Myomectomy
  3. Surgical removal w/uterine conservation
  4. Hysterectomy
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8
Q

Suitable fibroids for minimally invasive hysteroscopic sugery

A

Submucosal

Fibroid polyp

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9
Q

Which surgical procedures are indicated in bulky Fibroid uterus w/pressure Sx ?
(Or refractory to medical Rx)

A
  1. (laparoscopic)Myomectomy:
    - preservation of fertility
    - small but sig. risk of uncontrolled bleed -> hysterectomy
  2. Surgical removal of fibroids w/uterine convervation
  3. Hysterectomy
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10
Q

Which procedures for fibroid removal may be preceded with GnRH agonist? Why?

A

Hysterectomy and myomectomy
3mo
reduce bulk and vascularity of fibroid (allows suprapubic vaginal incision rather than midline TAH)
Quicker recovery, fewer Cx

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11
Q

Radiological Treatmeant of Fibroids?

A

Uterine Artery Embolisation

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12
Q

Uterine Artery embolisation procedure

A

Embolise both UAs under radio guidance
Cannula: femoral -> UA
Embolisation induces infarction and degeneration

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13
Q

% of Uterine artery embolisation procedures that reduce fibroid volume?

A

50%

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14
Q

Aftercare in Uterine artery embolisation

A

Often req. admission for pain, give opiate analgesia

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15
Q

Complications of uterine artery embolisation

A
Fever
Infection
Fibroid expulsion
Potential ovarian failure
Treatment failure (1/3 req. some treatment within 5y)
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16
Q

Counselling on fertility in uterine artery embolisation?

A

Effects uncertain

17
Q

Uterine artery embolisation effectiveness?

A

As effective as myomectomy for alleviating fibroid related HMB and pressure Sx

18
Q

Fibroids Summary

A
1st line symptomatic: LNG-IUS
Alternatives: TXA, COCP
GnRH red. size (usually pre surg)
Surgery: myomectomy, hysteroscopic ablation, hysterectomy
IR: UAE
19
Q

Adenomyosis

A

Endometrium breaks into myometrium

20
Q

Adenomyosis Ix

A

Ex: bulky, sometimes tender boggy uterus
USS: haemorrhage filled distended endometrial glands, may show irregular nodules (similar to fibroid)
MRI (BEST Investigation) - best images

21
Q

Adenomyosis Mx

A

Any treatment that induces amenorrhoea
LARCs (but Sx return on stopping)
Hysterectomy only definitive mx